Project Overview

Maine Medical Center is undertaking in the United States a replication of major studies underway or completed in the United Kingdom, Australia and Scandinavia. The focus of these efforts is to interrupt the very early progression of psychotic disorders. The goals are to improve outcomes and prevent the onset of the psychotic phase of illnesses like Bipolar Disorder, Major Depression, and Schizophrenia. What is at stake is the elimination of the disabling, long-term effects of major mental illnesses and their conversion to a vulnerability in individuals who nevertheless make meaningful contributions and have satisfying lives.

The Portland Identification and Early Referral Project (PIER) is comprised of a team of highly trained and well-experienced mental health professionals available to residents of the Greater Portland area to:

• Educate and train the provider community, the school professional work force, and other key professionals who might encounter young persons in the early stages of deterioration toward psychosis. This extends to the education of the entire area population.
  
• Identify, and help others to identify, young people who are manifesting prodromal (early signs) or active symptoms and signs of schizophrenia and other major psychotic disorders.
  
• Evaluate individuals’ risk for actual psychosis.
  
• Treat those who are at substantial risk with an empirically-tested package of psychosocial and psychopharmacological interventions.
  
• Maintain a long-term relationship with individuals and their families to assure the clinical and human support that have been found to be necessary to achieve a full secondary prevention effect.

The PIER Program is modeled on similar work being done in the United Kingdom, Australia, Scandinavia and Canada. The present experience suggests that it is possible to prevent the acute onset of major psychotic disorders. One major change that allows these effects to occur is the advent of clear premorbid indicators for the likely onset of psychosis. The other is the development of highly effective, yet relatively benign, psychosocial and drug treatments that can be tailored and used at exposure/dosage levels that do not subject young persons and their families to unacceptable risks. This combination of pharmacologic treatments and psychoeducational multifamily groups has a powerful effect on mediating the onset of psychosis. Under the direction of William McFarlane, MD, Director of the Center for Psychiatric Research, Maine Medical Center has more experience with systematic application of family psychoeducational intervention than any other medical center in the United States.